Provider Demographics
NPI:1093757593
Name:JEWETT, DAVID GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GEORGE
Last Name:JEWETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 IMPERIAL BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-3479
Mailing Address - Country:US
Mailing Address - Phone:615-822-3553
Mailing Address - Fax:615-822-5546
Practice Address - Street 1:107 IMPERIAL BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3479
Practice Address - Country:US
Practice Address - Phone:615-822-3553
Practice Address - Fax:615-822-5546
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000010375174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3150536OtherBLUECROSS
TN3172891Medicaid
TN3172890Medicaid
TN3172891Medicaid
TN3150536OtherBLUECROSS
TN3172891Medicare ID - Type UnspecifiedHENDERSONVILLE